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Sunday, May 25, 2014

Post-concussion program helps some patients heal faste - By Michelle Libby


In a week, physical therapists at OA Center for Orthopaedics in Windham, Portland, Saco and Brunswick will roll out a post-concussion therapy developed by staff physical therapist Bob Cochrane of Windham and Dusty Hurd. The program will be used on the 10 to 20 percent of concussed patients who do not get better after three weeks of rest, often still have symptoms like dizziness, sensitivity to light and slower reaction times. 
 
“It’s a misunderstood realm of medicine,” said Cochrane. “They are not visible with any kind of scan or imaging.” 

Concussions are caused by direct force trauma to the head. Most concussions resolve themselves in seven to 10 days. However there are a small percentage of patients who do not bounce back and need extra help.

According to the CDC, 1.6 to 3.8 million sports-related concussions happen every year. Thirty percent of all concussions are in athletes ages five to 19. There is also an increased incidence rate among high school and college females who play basketball and soccer. 

Dr. Jeffrey Bean sees close to 100 cases a year where a patient has a concussion. Bean, a DO, has a relationship with Windham High School and is the doctor students are referred to when they have a concussion. 

“Windham School system is ahead of the game for diagnosing and helping these kids in school,” Bean said. His focus is on getting the patients healthier. 

The test used at Windham High School is an IMPACT test that measures brain function and can signify cognitive issues rather than vestibular. “It’s a tool, but not the only answer to get back to sports,” he said. Getting a student back to class is more important to Bean. 

More attention has been given to concussions recently. The NFL has created a lot of concern about the severity of concussions. There has been an increase in the diagnosis of concussion recently. Cochrane said that it was because people know what to look for. There’s no more just shaking it off and getting back out on the field. 

“People are more aware of it…what to look for and potential ramifications long term,” said Bean. Bean describes a concussion like micro damage to the brain and it’s cumulative. It doesn’t repair itself.
“It’s a brain injury,” Cochrane stated. “There’s a huge need. I thought I could develop a program to get a lot of people better faster,” he said. 

The program was constructed painstakingly with research and evidence. The methods used to evaluate and treat the individual with this program is what is best to help them, Cochrane said. 

One part of the program deals with vestibular rehabilitation, which is part of the inner ear that communicates with the brain to sense movement. Vestibular talks to the eyes and the brain, but when that is off because of a concussion, it causes dizziness and the patient feels like they’re in a fog.  

The second part of the program is to work with the cervicogenic system (the neck) to help find new pathways to information a patient already knows. The third part is heart rate progression. With the increase in heart rate, symptoms usually increase in this population. Each time they get on a treadmill, they are seeing how long it is before the onset of symptoms. 

When a client first come to OA, they are tested on their saccadic eye movement, are given a full cervical exam and given a treadmill heart rate test. This will give the physical therapists a baseline to work with.
After a concussion, Bean recommends that patients limit the use of computers, the TV, reading, texting and listening to loud music. Anything that stimulates the brain should be avoided. Getting back to school work should be priority one. 

This concussion rehab is done on a case by case basis and all patients are given homework, which will help speed their recovery. 

Cochrane has been experimenting using this program since November, with very good results, he said. “It’s been overwhelmingly positive,” he said. One case he worked with a man who was in a motor vehicle accident and he wasn’t getting better. After two weeks working with Cochrane he was better and he was discharged after three weeks. 

Bean said that all the people they work with will get better, and this will help them get better faster. The program also works to increase and strengthen to cervical spine, which will speed the recovery. 

OA treats concussions and a wide variety of sports related injuries including casting broken bones and fitting athletes to new bicycles. For more about what they offer, visit www.orthoassociates.com.

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